Puberty is a significant milestone in a person’s life, marking the transition from childhood to adolescence. However, not everyone experiences this biological transformation at the same age. Some individuals may go through a phase known as delayed puberty, where the typical physical and hormonal changes associated with adolescence are delayed beyond the expected age range. 

In this comprehensive article, our team of pediatric endocrinology specialists in Miami delves into the various aspects of delayed puberty, including its definition, symptoms, causes, diagnosis, treatment options, and the crucial role of emotional support during this phase.

Late Puberty in Boys and Girls: What is It?

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Delayed puberty, medically referred to as “late puberty” or “delayed sexual maturation,” is a condition in which an individual’s development of secondary sexual characteristics, such as breast development in girls or facial hair growth in boys, as well as menstruation in girls, occurs later than the average age. While puberty typically begins between the ages of eight and 14 for girls and between nine and 15 for boys, delayed puberty is diagnosed when these changes are significantly delayed beyond this range.

How late can puberty start? As mentioned above, the late onset of puberty may begin at ages 14 and 15. If the children reach these ages without any significant bodily changes, their development might need to be evaluated by an expert.

What are the Symptoms of Delayed Puberty?

The primary symptom of delayed puberty is the absence or delay of typical secondary sexual characteristics. For girls, this can include a lack of breast development and/or the absence of menstruation. In boys, delayed puberty can manifest as a lack of facial hair growth, the deepening of the voice, and increased muscle mass. Emotional symptoms, such as feelings of self-consciousness or anxiety, may also be present due to the delayed physical changes.

The most common signs of puberty in girls include:

  • Growth spurts
  • Breast development
  • Pubic and underarm hair development
  • The hips start to widen, and their body shape becomes curvier
  • Girls will also start to get their period for the first time in puberty.

Signs of puberty in boys: 

  • Testicular enlargement
  • Facial, underarm, and pubic hair development
  • Growth spurt
  • Voice deepening
  • Increased muscular development and broader shoulders

What Happens in Delayed Puberty?

During puberty, the body undergoes a series of complex hormonal changes that trigger physical and emotional transformations. Late puberty in girls and boys essentially means that these changes are slower to occur or are postponed. This condition can affect an individual’s self-esteem, body image, and emotional well-being, as they may feel “different” from their peers who are experiencing these changes on schedule.

The Main Causes of Delayed Puberty

Various factors can contribute to delayed puberty. These include genetics, underlying medical conditions, nutritional deficiencies, excessive exercise, and psychological stress. In some cases, the cause may be idiopathic, meaning it is not immediately clear why puberty is delayed.

That said, late puberty in boys and girls may be sorted into two major categories, such as:

1. Family History

For the most part, delayed puberty can be attributed to a genetic developmental growth pattern. Meaning if a child’s uncle, brothers, sisters, aunt, parents, or cousins have developed later, the chances are high that this will happen to the child as well. This is referred to as constitutional delay, and in most cases, it requires no treatment. This is what people usually call “late bloomers,” who will also develop normally, just a bit later in life than others in their age group. 

2. Medical Complications

Several medical issues may trigger the late onset of puberty, such as:

  • Chronic Illness – Teens who have chronic illnesses like cystic fibrosis, diabetes, kidney disease, and asthma may experience puberty later because the illness may interfere with growth and development. Properly addressing these diseases may help avoid the late onset of puberty.
  • Malnourishment – Characterized by a deficiency of pivotal nutrients, Malnourishment may also cause delayed development. This may occur because of eating disorders, food insecurity, or excess exercise. For instance, teens with anorexia nervosa and other eating disorders may lose so much weight that their development stalls. 
  • Thyroid and Pituitary Gland problems
  • Chromosomal Disorders – There are also specific chromosome disorders that may delay puberty in some teens. Chromosomes are made up of DNA, the molecules that contain the biological and genetic information for the human body. When these chromosomes are “faulty,” it can affect standard development. These disorders include specific medical conditions such as Klinefelter syndrome and Turner syndrome. In the latter, teens may go enter puberty normally, but the development will eventually stall or stop. In the case of Klinefelter syndrome, puberty will also start at a normal age but will stall.

How to Diagnose Late Puberty

Diagnosing delayed puberty involves a thorough medical evaluation by a healthcare provider. This assessment typically includes a detailed review of previous medical history, physical examination, and various other tests, such as hormone level measurement and a bone age assessment. These tests can help determine the underlying cause and severity of the delayed development.

How to Treat Delayed Puberty

The treatment of delayed puberty ultimately depends on its underlying cause. In some cases, no specific treatment may be necessary, as the individual may eventually catch up in their development. However, if an underlying medical condition is identified, it should be addressed accordingly. Hormone therapy may be recommended in certain cases to stimulate the onset of puberty.

What Are The Consequences of Late Puberty?

Late puberty, also known as delayed puberty, can have various consequences, both physical and emotional. It is important to note that these consequences can vary from person to person and depend on the underlying causes and individual circumstances. Here are some of the potential side effects of late puberty:

Physical Side Effects:

  • Short Stature: Delayed puberty can lead to a shorter final adult height because the growth plates in the bones may close prematurely.
  • Bone Health: Late puberty can affect bone density, potentially increasing the risk of osteoporosis or bone fractures later in life.
  • Body Composition: Late bloomers may have differences in body composition, such as lower muscle mass or increased body fat, compared to their peers.
  • Reproductive Health: Delayed puberty can affect fertility in both males and females, as it may delay the development of reproductive organs and the onset of regular menstrual cycles.

Emotional Side Effects:

  • Psychological Distress: Adolescents experiencing late puberty may face psychological distress, including anxiety, depression, and low self-esteem, as they may feel “different” from their peers.
  • Social Challenges: Delayed puberty can lead to social challenges, as individuals may struggle with fitting in or feeling left behind in terms of physical development.
  • Body Image Concerns: Adolescents may experience body image concerns, as they may perceive themselves as less physically mature than their peers.
  • Peer Pressure: The pressure to meet societal norms and peer expectations can be particularly challenging for individuals going through late puberty.
  • Academic Performance: Emotional distress related to late puberty can sometimes affect academic performance and overall well-being.

The Importance of Emotional Support During Delayed Puberty

Emotional support is crucial for individuals experiencing delayed puberty. Adolescence can be challenging, and feeling “out of sync” with peers can be emotionally distressing. Parents, caregivers, and healthcare providers are key in providing understanding, reassurance, and guidance during this time. Encouraging open communication and fostering a positive body image can significantly help individuals cope with the emotional aspects of delayed puberty.

What Can Parents Do?

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Here are some steps parents can take to provide support for their children experiencing delayed puberty:

  • Open Communication: Create a safe and open environment for your child to discuss their concerns and feelings.
  • Educate: Help your child understand the concept of delayed puberty, its causes, and the fact that everyone develops at their own pace.
  • Consult a Healthcare Provider: If you suspect delayed puberty, consult a healthcare provider for a thorough evaluation and guidance on appropriate steps to take.
  • Emphasize Self-Esteem: Encourage your child to focus on their strengths and achievements rather than solely on physical changes.
  • Seek Support: Consider seeking support from a therapist or counselor if emotional issues arise.


Delayed puberty is a condition that requires understanding, patience, and support. While potentially emotionally challenging, it is essential to remember that it is a natural variation in human development. By identifying the causes and addressing any underlying issues, individuals experiencing delayed puberty can successfully navigate it and ultimately reach their full physical and emotional potential.